儿童时期危险因素与远期动脉僵硬度的关系：26年队列随访研究  

The relationship between childhood risk factors and long-term arterial stiffness:a 26-year follow-up study

作　　者：褚超[1] 牟建军[1] 杨睿海[2] 王曼[1] 杨军[2] 任勇[2] 谢冰清[1] 董珍珍[1] 杨璠[1] 王丹[1] 严定一 郭统帅[1] 汪洋[1] 刘治全[1] 

机构地区：[1]西安交通大学医学院第一附属医院心内科,陕西西安710061 [2]汉中市人民医院心血管病研究所

出　　处：《中华高血压杂志》2014年第8期737-741,共5页Chinese Journal of Hypertension

摘　　要：目的探讨儿童时期危险因素与远期动脉僵硬度间的关系。方法 1987年对陕西汉中农村6-15岁在校学生4623人进行血压、身高、体质量基线调查。将1987、1989、1992年3次不同年份测量的收缩压持续≥同年龄、同性别第75百分位者（P75）确定为血压偏高组（n=170）,收缩压〈同年龄、同性别P50者为正常血压组（n=200）。26年后（2013年）再次对该队列进行血压等随访,同时检测空腹血糖、血尿酸、血脂,无创自动波形分析仪测量臂踝动脉脉搏波传导速度（baPWV）,采用多元线性回归分析基线期和随访期危险因素与随访期baPWV之间的关系。结果总随访率为71.6%。血压偏高组随访期发生高血压的比例高于正常血压组[39.5%比18.0%,P〈0.01],baPWV大于正常血压组[（1337.2±198.3）比（1271.7±204.3）cm/s,P=0.03]。相关分析显示,baPWV与基线期收缩压及随访期收缩压、舒张压、心率、体质量指数、总胆固醇、低密度脂蛋白胆固醇、三酰甘油、空腹血糖、尿酸呈正相关（P〈0.05）。多元逐步线性回归分析显示,男性、高血压家族史、基线期收缩压、随访期收缩压、空腹血糖和尿酸是baPWV的独立影响因素。结论儿童时期收缩压偏高、高血压家族史以及男性可能是远期动脉僵硬度增加的危险因素。Objective To explore the relationship between childhood risk factors and long-term arterial stiffness. Methods A baseline survey was carried out in 4623 school children aged 6-- 15 years in rural areas of Hanzhong city, Shaanxi in 1987. According to three independent measurements of systolic blood pressure （SBP） in 1987, 1989 and 1992, those whose SBP≥75 percentile at same age and gender continuously were defined as high blood pressure group （ HBP group}, while SBP〈50 percentile as normal blood pressure group （NBP group）. The cohort was followed up again 26-years later（in 2013）. At the same time, blood biochemical indexes were measured, including fasting glucose, uric acid and blood lipid. Brachial-ankle pulse wave velocity （baPWV） was recorded by noninvasive automatic waveform analyzer. Results The follow-up rate was 71.6%. HBP group versus NBP group had higher incidence of hypertension （39.5% vs 18.0%, P〈0.01） and baPWV [（ 1337.2 ± 198.3） vs （ 1271.7 ± 204.3）cm/s, P= 0.03] in this follow-up period. BaPWV at follow-up was positively correlated with childhood SBP and SBP, diastolic blood pressure（DBP）, body mass index, heart rate, total cholesterol（TC） ,low density lipo- protein cholesterol{LDL-C）, triacylglycerol（TG）, fasting glucose and uric acid in adulthood （all P〈0.05）. In stepwise multivariate regression analysis, male, family history of hypertension, SBP at both baseline and follow-up, fasting glucose and uric acid in adulthood were independent impact factors of baPWV in adults. Conclusion Higher SBP in children and adolescents, family history of hypertension and male gender may increase the risk of developing long-term arterial stiffness.

关 键 词：臂踝动脉脉搏波传导速度 儿童 成年 队列研究 

分 类 号：R725.4[医药卫生—儿科]